Chances are your doctor and you are confused about Covered California

Most of 2,300 physicians surveyed statewide said they were confused about their participation in health networks sold on the Covered California exchange, which has led to negative impacts on patient care, according to results released Thursday.

The California Medical Association sent e-mails to physicians who were members of medical associations statewide and received responses to 15 questions in two days. At least 80 percent of those who responded said they were confused about their participation status in the new networks. More than half said they lost patients.

The survey results and letter were sent to Covered California Executive Director Peter Lee late last month.

“The state of confusion over Covered California networks needs to be addressed before the next open enrollment period,” Dr. Richard Thorp, president of the California Medical Association, said in a statement. “This survey shows that the mass confusion about participation status for both patients and physicians has led to patient access issues, loss of patients and has negatively impacted patient care in our state.”

Covered California, the state’s health exchange, opened its first enrollment period on Oct. 1 and closed it in mid-April. About 1.4 million Californians enrolled through the exchange statewide, representing 17 percent of all those who bought health insurance across the U.S.

During a board meeting Thursday, Covered California officials outlined some of the improvements that need to be made to ensure the adequacy of networks, but said the largest networks already expanded the number of providers.

Advertisement

In their own analysis, Covered California officials found there were less than 200 cases of patients who reported problems with continuity of care since January.

In the first quarter of this year, 1,100 complaints were made to the Department of Managed Health Care.

“Health plans are continuing to expand their networks to assure adequate capacity, including additional clinicians and groups being added by Anthem, Shield and Health Net,” according to Covered California.

A similar statement was made Thursday by the California Association of Health Plans, which added that the medical association’s release of the results are part of the group’s backing of a bill that would allow physicians to opt out of services within a network.

“There are certainly growing pains from the overhaul of our health care system, but unfortunately some groups are trying to use this as an excuse to pursue a policy that is harmful to the success of Covered California,” said the association’s executive vice president Charles Bacchi.

Molly Weedn spokeswoman for the medical association, said physicians just want to be able to help patients.

“The biggest concern for CMA’s members is to have the most information they can when patients call them,” she said. “Access to health care is more than just a card in your pocket.”